peds exam 1 (pain/fluids/GI/GU)

PSGN (post Streptococcal Glomerulonephritis)

PEAKS @ 7yo

fluid overload (high RR&HR), cola urine, flank pain, HTN

PSGN nursing care

daily weights, strict I&Os, bedrest if HTN

HUS (hemolytic uremic syndrome)

abd pain, vomiting, diarrhea (bloody from ecoli), pallor (anemia), bruising (less platelets), oliguria, HTN (renal issues), hematuria

HUS nursing care

dialysis, I&Os, RBC & platelets for transfusions

nephrotic syndrome

1st sx → PERIORBITAL EDEMA

Diagnostic triad → proteinuria, hypoalbuminemia, hypercholesterolemia

nephrotic syndrome care

STEROIDS to decrease protein loss

manage SE of steroids (stunts heights)

monitor K, elevate legs

daily weights to see fluid shifts

low Na & high protein

Testicular Torsion

12-18yo

acute scrotal pain, N/V

Diagnosis → cremasteric reflex

Tx → manual detorsion 1st, orchiopexy 2nd

Cryptorchidism

failure of 1 or both testes to descend → possible sterility complications

Diagnostics → elicit cremasteric reflex (have warm hands)

Cryptorchidism care

Can resolve within 9 months, after won’t descend on their own

Tx → orchiopexy

Epispadia (top of penis) & Hypospadia (below penis) Care

foley post op

pain management

use double diapering

VUR (cesicouretal)

born w/ short ureter and valve underdeveloped → creates backflow to ureter into kidney

VUR grades

grades 4-5 increases renal scarring

VUR risk factor

screen all kids YOUNGER THAN 6yo

VUR s/sx

Infants w/ UTI & fever

Hydronephrosis

VUR diagnostics

noninvasive → renal US

invasive → VCUG, needs infection to resolve first

VCUG care

let child have comfort item, reassure, sit on parents lap

VUR care

post op spasms

post op pain

Enuresis

night time incontinence older than 5yo

Enuresis patho

most children trained by age 5 from myelination by age 4

enuresis diagnostic

1st choice urinalysis

enuresis tx

bed alarms

limit intake

no caffeine

retention control training via KEGEL exercises

UTI cystitis

local bladder infection

Urethritis

secondary to labial adhesions from decreased estrogen levels in females

pylenonephritis

infection IN KIDNEY

Hirschsprung Dx

lack of ganglion cells in GI tract → no peristalsis → constipation

Hirschsprung s/sx

failure to pass meconium after 24 hrs

Hirschsprung diagnosis

biopsy needs correct areaH

Hirschsprung care

look for bleeding

ostomy care

increase fluids if increased output

Hirschsprung complications

aganglionic areas can spread and these never absorb nutrition → short gut syndrome & needs TPN

pyloric stenosis

vomits immediately AFTER eating (projectile vomitting)

pyloric stenosis s/sx

olive shape mass RUQ, severely dehydrated, hungry

pyloric stenosis care

CLEAR LIQUIDS 1st!

pain management

monitor electrolytes/hydration

esophageal atresia FISTULA

fluids go into lungs from fistula connecting lungs/esophagus

esophageal atresia fistula tx

make NPO, suction secretions, Gtube feeds

GER s/sx

regurgitating/vomitting, silent aspiration (bradycardia sxs), kids arch in pain from acid burning throat

GER diagnostic

pH probe 24 hrs - checks pH in 24 hr period and amount of times pH drops from stomach acid

GER Tx

no swings or laying flat 30 mins post feed, keep upright, use thicken formula, feed more often Q3H

GER meds

antacids

omeprazole (PPI)

cleft lip and palate risk factor

low folic acid

cleft lip and palate tx

haberman feed & surgerys

cleft lip and palate care

decrease pain

overall comfort

iced saline to lip to decrease edema

aspiration precautions

CDH

opening in diaphragm allows abd contents into thoracic cavity

CDH s/sx

resp distress

decreased breath sounds in affected sides

bowel sounds in chest

pulmonary HTN

CDH diagnostics

ECHO

CDH care

give o2 via intubation for pulm HTN

enteral feeding w/ high calorie formula OR TPN

Intussusception

intestines fold in on itself (telescoping) → edemai

intussusception s/sx

JELLY LIKE STOOL

colic type pain

sausage mass RUQ

intussusception tx

air enema

NEC

dead gut

NEC s/sx

abd distention, bloody stool

NEC diagnostics

dilated loops of bowel seen and free air

NEC care

STOP FEEDS IMMEDIATELY

call provider

NEC tx

abd girth q4-8H, TPN, antibiotics

Bilary Atresia s/sx

clay stool, jaundice, ascites

bilary atresia care

daily weight, abd girth, monitor labs CVL

bilary atresia tx

needs liver transplant

malrotation & volvulus tx

gastric decompression, NPO, hydration w/ TPN

TPN rules

check glucse and wean on/off

med compatibility? no? → stop tpn, run antibiotic in Dextrose line, infuse antibiotic at same rate of TPN

intolerance feeding s/sx

diarrhea

abd distention

intolerance tx

slow feed and double check what youre giving

1ST V/S DEHYDRATION

HR IS TACHYCARDIC

anterior fontannels

open 12-18 months

opioids se tx

constipation → decrease dosage, HYDRATION

resp distress → assess RR, naloxone, spo2

urinary retention → monitor I&Os, apply warm compression over bladder, move

opioids PO

preferred → last 4 hrs NEED BM PRIOR